Abstract

Introduction

Laparoscopic cholecystectomy has usually been performed using three or four ports. As expertise with the technique has improved, however, we have begun to use only one or two ports. Here we report differences between the previous and present methods of gasless single-incision laparoscopic cholecystectomy (SILC).

Patients and methods

Twelve patients (7 males and 5 females aged between 30 and 75 years, mean 56.5 years) were enrolled in this study. The mean BMI was 25.8 (range: 22.5-37.1) kg/m2. They were divided into two groups depending on the procedural period (Group1, November 1997-June 1998, and Group 2, December 2009-March 2010). Under general anesthesia, a 2.5 cm vertical incision was made at the umbilicus, and the operating field was created using the original abdominal wall-lift method with a rigid bar. Two 5-mm ports were placed through the same umbilical incision but through separate fascial incisions. After exposing the Calot triangle, the hilum of the gallbladder was dissected laterally and medially to expose the cystic duct and artery, which were then ligated with clips and divided with scissors or coagulating shears. The gallbladder was retrieved using a retrieval bag.

Results

We performed SILC successfully in 10 cases, and the other 2 in Group 2 required conversion to SILC with pneumoperitoneum due to difficulty with the surgical procedure. However, none of the procedures required conversion to open cholecystectomy or addition of other ports. The mean operation time and postoperative hospital stay was 202 min and 7.0 days, and 115 and 3.2 in Group 1 and 2, respectively. There were no intra- or postoperative complications.

Conclusion

Although evaluation of our operative outcomes is still premature due to lack of sufficient experience, our present series shows that gasless SILC is technically feasible and safe for any surgeon sufficiently experienced in the standard technique of laparoscopic cholecystectomy and has additional aesthetic and cost advantages.